Update on cryptorchidism: endocrine, environmental and therapeutic aspects, 2003
There is a clear trend for an increased incidence of testicular cancer and the causes are still unknown. An increased risk of cryptorchidism has been observed in the sons of mothers exposed to diethylstilbestrol during pregnancy. It is well established that cryptorchidism is a risk factor for testicular cancer.
The risk of testicular cancer could be linked to the persistance of gonocytes and the absence of normal spermatogenesis. The prevalence of carcinoma in situ in cryptorchid patients is about 2 to 3%. It has a potential evolutive risk toward invasive cancer, justifying for some testicular biopsies in adulthood . However, even if the apparent secular increased incidence of cryptorchidism is true, it is unlikely that it could explain in full the increased incidence of testicular cancer.
RR of testicular cancer in men with history of cryptorchidism varies between 5 and 10 depending on studies. In a Danish study, the RR was 5.2 for the cryptorchid testis. The risk was also increased at 3.6 for the contralateral testis. Two prospective cohort studies have found a RR of 4.7 and 7.4. The risk was higher for bilateral cryptorchidism with a RR up to 33 (2) or for an intra-abdominal testis (6-fold risk as compared to a testis in a lower position).
This increased risk of testicular cancer is a major concern, as it is a cancer of young men. Early orchidopexy is even more important in abdominal testis, since in the absence of surgical correction, the follow-up with screening for cancer would be seriously impaired.
Some studies suggest that the risk of testicular cancer may not be decreased after surgery, but they examined patients who underwent relatively late orchidopexy. Other studies are more optimistic, showing a weak tendency for a decreased odd ratio with a younger age at orchidopexy.
Prospective studies are necessary focusing on patients who underwent surgical treatment before age 1 or 2, compared to others treated later.
- Update on cryptorchidism: endocrine, environmental and therapeutic aspects, Journal of endocrinological investigation, NCBI PubMed, PMID: 12952375, 2003.
- Featured image Joel Bader.